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Monday December 16, 2013 7:11 AM

Q: Transcranial magnetic stimulation is a treatment for depression that involves undergoing a procedure for 30 to 40 minutes a day for four to five weeks.

Do you know how successful the noninvasive treatment is?

To your knowledge, is it successful — and advised for older people, too?

It has been successful for some patients, according to the research I’ve done, but I wanted your opinion.

I understand that it isn’t yet covered by Medicare, so, for those whose primary coverage is Medicare, that means that the secondary doesn’t cover it, either.

It is being recognized in some areas and gradually being covered by some insurance plans.

Are you familiar with the treatment, and do you see it as a viable alternative for those who can’t take antidepressants?

A: I hadn’t heard of the treatment before your letter and was surprised to find good evidence to support its use.

It is more effective than a placebo treatment, but only about 25 percent of people — all of whom had a poor response to at least one medication — had a good response to treatment. The major side effect involves seizures but only in less than 1 percent of cases.

Because of differences in brain structure, elderly patients might require a higher intensity of magnetic stimulation.

The treatment seems to be a useful alternative therapy.

Other antidepressant medications, electroconvulsive therapy and — especially — non-pharmacological treatments such as cognitive behavioral techniques, however, might be effective in a larger number of people.

Q: I am 76 and have a condition called Wenckebach phenomenon — an irregular heartbeat.

For most of my life, I have exercised frequently and been in excellent health.

I have run 22 marathons. My heart rate is in the low 60s, and I don’t take beta blockers. The condition is asymptomatic and doesn’t seem to affect my exercise. Through a consultation with my cardiologist, he determined that I don’t need a pacemaker. What is my prognosis?

A: Wenckebach is a heart-rhythm disturbance, called a heart block.

Three degrees exist. First-degree block is the mildest and rarely needs treatment, although it might predict more serious heart problems. Second-degree block comes in two varieties: type I (Wenckebach), which you have; and type II, which usually requires a pacemaker because it often proceeds to type III, or complete heart block — which requires a pacemaker immediately.

“Heart block” sounds scary, but Wenckebach usually has a good prognosis. In trained athletes with slow heart rates, Wenckebach is common — in about 10 percent of athletes.

Because you have no symptoms, I agree with your cardiologist and can reassure you that the chance of developing a worse heart block is low.

Dr. Roach answers letters only in his North America Syndicate column but provides an order form of available health newsletters. Write him at P.O. Box 536475, Orlando, FL 32853-6475; or ToYourGoodHealth@med.cornell.edu.